Graft-versus-host disease future or investigational therapies

There are a few new investigational efforts in place for GvHD prevention, diagnostics, and therapeutics. These include Aurora kinase inhibitors, capsule endoscopy, and ibrutinib.

• Regarding prevention, studies have shown that []Aurora kinase]] may be a targetable pathway to prevent GvHD.^[1] Transcriptome analysis of CD3-positive T cells from primates during acute GvHD has led to the discovery that Aurora kinase is a druggable target. Aurora kinase inhibitors are available and may be applied to GvHD if future data continues to be promising.^[1] Additional preventive strategies include optimization of the graft-versus-tumor and GvHD balance in favor of a graft-versus-tumor effect. This balance might be achieved by manipulating regulatory T cells or NKT cells.^[2]

• Regarding diagnostics, early and more sensitive diagnostic strategies are being studied. Wireless capsule endoscopy has been proposed for upper GI GvHD diagnosis.^[3] A pilot study of 15 patients showed that wireless capsule endoscopy could be a novel method for early GI GvHD diagnosis. The benefits are that this procedure is less invasive that a traditional endoscopy and bypasses the potential problem of false negatives, given patchy distribution of inflammation in GI GvHD.^[3]

• Regarding therapeutics, there are a few medications that are currently being investigated for GvHD treatment. Such examples include ibrutinib (a Bruton’s tyrosine kinase inhibitor) and ruxolitinib (a JAK2 inhibitor). These medications are not formally FDA-approved thus far, but they may become approved in the near future pending further clinical studies.

There are a large number of clinical trials either ongoing or recently completed in the investigation of graft-versus-host disease treatment and prevention^[4].